Provider Demographics
NPI:1528149770
Name:VARANASI, MALATHY (MD,)
Entity type:Individual
Prefix:
First Name:MALATHY
Middle Name:
Last Name:VARANASI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KENDRICK LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7815
Mailing Address - Country:US
Mailing Address - Phone:631-423-8951
Mailing Address - Fax:
Practice Address - Street 1:13 KENDRICK LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7815
Practice Address - Country:US
Practice Address - Phone:631-423-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130342207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19325Medicare UPIN
NY78A881Medicare ID - Type Unspecified